Nurses, midwives to prescribe MTOP drugs

5 minute read

The bill would make Queensland our first jurisdiction to allow non-doctors to give out mifepristone and misoprostol.

Queensland nurses and midwives will be able to prescribe medical abortion drugs under proposed changes to the state’s Termination of Pregnancy Act 2018 and Criminal Code. 

The Health and Other Legislation Amendment Bill 2023, introduced to Queensland parliament earlier this week, would allow nurse practitioners and endorsed midwives to prescribe mifepristone and misoprostol (MS-2 Step, MS Health Pty Ltd) for patients in the early stages of pregnancy. 

It comes after the TGA scrapped restrictions on prescribing MS-2 Step in August, paving the way for individual states and territories to allow other healthcare practitioners, such as nurses, to prescribe the drug.  

Queensland is just the first jurisdiction to take that action.  

The Bill includes amendments to four health portfolio Acts, including the state’s Termination of Pregnancy Act 2018, and the Criminal Code with the aim of expanding access to medical termination services across the state. 

The Labor government holds a majority in Queensland’s singular house of parliament, making the bill’s passage all but guaranteed.  

While expanded scope of practice is a frequent cause of concern among doctors, reactions from the medical community have largely been positive. 

“The introduction of this legislation in Queensland is monumental as it will empower nurses and midwives to play a crucial role in abortion care,” MSI Australia (formerly Marie Stopes International) clinical excellence director Dr Catriona Melville said. 

“Having more health practitioners able to provide medication abortion means fewer people will have to travel, often hundreds of kilometres, to access medical abortion.  

“And it will also mean less stigma in the community as abortion care becomes more like other essential health services. 

RACGP Queensland chair Dr Cath Hester told The Medical Republic that the college was in favour of women having access to a full suite of reproductive services.  

“If involving nurse practitioners and suitably trained, endorsed midwives to help provide these services will help improve access – especially to vulnerable parts of the population – then we’re in favour of that,” she said.  

“But we have to balance … ensuring access against ensuring the safety and quality of the services provided.  

“We’re obviously very keen to see the state government also provide assurances that practitioners who are providing these services are appropriately trained and qualified and working within a safe team environment of practitioners.” 

Dr Hester also noted that including nurse practitioners to prescribe medical termination of pregnancy would not reduce the state government’s responsibility to provide safe pathways for women who choose or require a surgical termination.  

Queensland’s move coincides with the beginning of a new project from high-profile GP and women’s health researcher Professor Danielle Mazza, which will be investigating nurse-led contraceptive and medical abortion care in rural Australia.  

Professor Mazza’s ORIENT trial is working with 32 rural and regional GP practices to determine whether nurse practitioner-led MTOP and long-acting reversible contraceptive prescribing will increase access to terminations.  

“I think the concern that people have is, of course, around training,” she told TMR.  

The expectation for any nurse practitioner medical abortion prescribers, Professor Mazza said, is that they will undertake similar training to what was previously required of doctors who wished to be authorised medical abortion prescribers.  

According to Queensland’s Minister for Health Shannon Fentiman, widening the scope of health professionals able to prescribe MS-2 Step was vital to overcoming existing disparities in access to safe medical abortion services across the state. 

“Access to safe termination of pregnancy care is a basic human right that remains a significant health issue for Queenslanders,” Ms Fentiman said. 

“Nurses and midwives have the necessary skills, experience, qualifications and training to be able to undertake this important role and provide greater access to reproductive healthcare, particularly in rural and remote communities. 

“This Bill will support more equitable access to termination of pregnancy care and pregnancy health care right across the state.” 

The proposed legislative changes would also increase minimum midwife-to-patient ratios at Queensland’s major hospitals to one midwife for every six patients. 

Under the amendments, newborn babies staying in the same hospital room as their birth parent would now be counted as separate patients. 

Kate Veach, Secretary of Queensland’s Nurses and Midwives Union, said the proposed legislation was a “huge win” for the state. 

“Ensuring each baby is counted as an additional patient alongside the mother is also an Australian first,” Ms Veach said. 

“Once this legislation is passed, Queensland Health will lead the way in the provision of safe, public inpatient maternity care in Australia. 

“Today is a great day for Queensland.”

References to “woman” will also be replaced with “person” under the new legislation to make access to termination services more equitable for LGBTQIA+ Queenslanders. 

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